Introduction: Unilateral biportal endoscopic (UBE) technique is an emerging minimally invasive spinal surgical technique that has been used to treat a variety of degenerative spinal diseases in recent years, while there are rare reports on the treatment of lumbar tuberculosis (LTB). Consequently, this study intends to investigate the effectiveness and feasibility of UBE debridement, interbody fusion, and percutaneous pedicle screw fixation for single-segment LTB. Methods: A total of 31 patients with single-segment LTB from January 2020 to September 2021 were included. The operative time, estimated blood loss, time to ambulation, postoperative hospital stay, and complications were recorded. Clinical outcomes include erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), the visual analog scale (VAS) score, Oswestry disability index (ODI), American Spinal Injury Association (ASIA) neurological classification, Cobb angle, and lumbar lordotic angle were analyzed. X-rays or computerized tomography (CT) were reviewed 6 months after surgery and at the final follow-up, and surgical segmental fusion was evaluated using Bridwell grading criteria. Results: The mean operative time was 171.61 ± 19.03 minutes, the mean estimated blood loss was 243.87 ± 26.54 ml, the mean time to ambulation was 1.87 ± 0.76 days postoperatively, and the mean postoperative hospital stay was 5.61 ± 1.17 days. There were 4 cases of procedure-related complications and the incidence was 12.9%. The levels of ESR and CRP returned to normal 3 months after the procedure. VAS scores of low back and leg, as well as ODI, were significantly improved postoperatively compared with before the operation, and the differences were statistically significant (P < 0.05). All patients were ASIA grade E at the last follow-up. The postoperative Cobb angle was 9.81 ± 2.4°, the lumbar lordotic angle was 42.59 ± 6.16°, and both had no significant loss of correction during the final follow-up. Bony fusion was achieved in all cases at the final follow-up. Conclusions: UBE debridement, interbody fusion, and percutaneous pedicle screw fixation is a feasible, effective, and safe surgical procedure for the treatment of single-segment LTB.

BACKGROUND:Complete fractures and dislocations of the lower cervical spine are usually associated with severe spinal cord injury. However, a very small number of patients do not have severe spinal cord injury symptoms, patients with normal muscle strength or only partial nerve root symptoms, known as "lucky fracture dislocation". The diagnosis and treatment of such patients is very difficult. Recently, we successfully treated one such patient.CASE PRESENTATION:A 73-year-old male patient had multiple neck and body aches after trauma, but there was sensory movement in his limbs. However, preoperative cervical radiographs showed no significant abnormalities, and computed tomography (CT) and magnetic resonance imaging (MRI) confirmed complete fracture and dislocation of C7. Before operation, the halo frame was fixed traction, but the reduction was not successful. Finally, the fracture reduction and internal fixation were successfully performed by surgery. The postoperative pain of the patient was significantly relieved, and the sensory movement of the limbs was the same as before. Two years after surgery, the patient's left little finger and ulnar forearm shallow sensation recovered, and the right flexion muscle strength basically returned to normal.CONCLUSION:This case suggests that when patients with trauma are encountered in the clinic, they should be carefully examined, and the presence of cervical fracture and dislocation should not be ignored because of the absence of neurological symptoms or mild symptoms. In addition, positioning during handling and surgery should be particularly avoided to increase the risk of paralysis.

Objective:This study aims to investigate the effectiveness and feasibility of biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis (LBS).Methods:The data of 13 patients with LBS were retrospectively analyzed, who underwent biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation from May 2020 to June 2022. The patients' clinical data, the duration of operation, the estimated blood loss (including postoperative drainage), and complications were recorded. Clinical outcomes include serum agglutination test (SAT) measures Brucella antibody titer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at the final follow-up. The intervertebral bone graft fusion was assessed using the Bridwell grading criteria.Results:The mean operation duration was 177.31 ± 19.54 min, and the estimated blood loss was 176.15 ± 43.79 ml (including postoperative drainage was 41.15 ± 10.44 ml). The mean follow-up period was 13.92 ± 1.5 months. SAT showed that the antibody titers of 13 patients were normal 3 months after the operation and at the final follow-up. ESR and CRP levels returned to normal by the end of the 3-month follow-up. VAS scores of low back and leg, JOA score, and ODI significantly improved after the operation throughout the follow-up period (P < 0.05). Based on the modified Macnab criteria, 92.3% showed excellent to good outcomes. One patient had only a percutaneous screw internal fixation on the decompression side due to severe osteoporosis. One case suffered a superficial incision infection postoperatively that healed with dressing change and effective antibiotic treatment. Bony fusion was obtained in all patients at the last follow-up, including 12 cases with grade I and 1 case with grade II, with a fusion rate of 92.31%.Conclusion:Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation is an effective, safe, and viable surgical procedure for the treatment of LBS.

目的 探讨单侧双通道内镜下腰椎椎间融合术(unilateral biportal endoscopic lumbar interbody fusion,UBE-LIF)治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)的疗效和影像学结果.方法 回顾性分析2021年3月至2022年3月在新疆医科大学第一附属医院骨科接受UBE-LIF治疗的63例LSS患者的资料,男24例,女39例;年龄45～75岁,平均年龄(61.17±7.88)岁.记录患者的手术时间、术中出血量、术后引流量、术后下地时间、术后住院时间和并发症情况.采用腰背部和腿部视觉模拟评分(visual analog scale,VAS)、日本骨科协会(Japanese orthopaedic association,JOA)评分、Oswestry 功能障碍指数(Oswestry disability index,ODI)及改良 Macnab 标准评估临床疗效.术后6个月和末次随访复查X线片或CT评估影像学结果,并采用Bridwell分级标准评估手术节段融合情况.结果 63例患者手术均顺利完成.手术时间100～195 min,平均(139.37±20.88)min;术中出血量85～190 mL,平均(124.52±21.58)mL;术后引流量 15～65 mL,平均(35.48±10.34)mL;术后下地时间 1～3 d,平均(1.70±0.59)d;术后住院时间3～6 d,平均(4.53±0.59)d.术后随访12～20个月,平均(15.20±2.23)个月.共发生8例并发症,发生率为12.69％.术后各随访时间点腰背部和腿部VAS、JOA评分及ODI均较术前明显改善,差异有统计学意义(P＜0.05).末次随访时改良Macnab标准评价,优48例(76.19％),良8例(12.70％),可7例(11.11％),优良率88.89％.术后 6 个月随访时,Bridwell 分级 Ⅰ 级 15 例(23.81％),Ⅱ 级20 例(31.75％),Ⅲ级 24 例(38.10％),Ⅳ级 4 例(6.35％);末次随访时,Bridwell分级Ⅰ级58例(92.06％),Ⅲ级5例(7.94％).结论 UBE-LIF治疗LSS具有良好的疗效和影像学结果,是一种安全、有效的微创融合手术方式,可为LSS患者提供新的治疗选择.

随着微创脊柱外科的快速发展，单侧双通道内镜（UBE）技术被广泛用于治疗腰椎退行性疾病。近年来，在国内外学者不断探索和改良下，该技术也被用于治疗颈胸椎疾病、脊柱感染性疾病及椎管内占位性病变等，且能与颈椎前路椎间盘切除融合术及内镜下椎弓根螺钉置入术等微创技术结合使用。本文就UBE技术在脊柱疾病中的应用进展进行综述，对该技术的优势进行总结，并对未来的应用前景进行展望。

ObjectiveThe purpose of this study was to investigate the clinical efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) for lumbar spinal stenosis (LSS).MethodsPatients who underwent UBE-TLIF due to single-segment LSS between August 2019 and July 2021 were retrospectively included in the study. Clinical outcomes evaluated include operative time, estimated blood loss (including postoperative drainage), time to ambulation, postoperative hospital stay, complications, visual analog scale (VAS) scores of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and modified Macnab criteria. Interbody bony fusion at the index level was assessed using Bridwell grading criteria.ResultsA total of 73 patients (29 males and 44 females) were enrolled in this study. All surgeries were successfully performed without intraoperative conversion to open surgery. Magnetic resonance imaging (MRI) revealed optimal direct neural decompression after UBE-TLIF. The mean operative time was 150.89 ± 15.58 min. The mean estimated blood loss was 126.03 ± 17.85 ml (postoperative drainage was 34.84 ± 8.31 ml). Time to ambulation was 2.0 ± 0.75 days after the procedure. Postoperatively, the mean hospital stay was 5.96 ± 1.38 days. VAS scores of low back pain and leg pain, JOA, and ODI were significantly improved postoperatively compared with those before the operation, and differences were statistically significant (P < 0.05). Excellent and good outcomes were reported by 87.67% of patients according to the modified Macnab criteria at the final follow-up. A total of nine perioperative complications occurred, with an incidence of 12.33%. X-ray or computerized tomography (CT) 6 months after the procedure showed that 37 cases (50.68%) presented with segmental fusion, 30 cases (41.10%) showed incomplete fusion, and 6 cases (8.22%) showed no signs of fusion. However, bony fusion was achieved in all cases at the final follow-up.ConclusionsUBE-TLIF for LSS has the advantages of less surgical invasiveness and fast postoperative recovery.